: The proposed research demonstration project will provide rural outreach services modeled on TCL/PACT service principles to mentally-ill clients in rural areas of two South Carolina counties (Charleston and Dorchester) and document the efficiency and effectiveness of providing these services in the client's home environment. These services have been field tested for over one year in the Rural Outreach, Advocacy, and Direct Services (ROADS) program of the Charleston/Dorchester Mental Health Center. The rural sites for this project meet the U.S. Census Bureau definition by having a population of under 2,500 persons. Additionally, these rural communities differ from urban areas by virtue of their citizens' poverty, illiteracy, poor health, inadequate transportation facilities, and limited access to telephones and other services. Many, if not most, mental health center clients are unable to follow complicated instructions; to complete required application forms; or even to read or write. Some mentally ill citizens exist untreated in their communities until their need for services necessitates institutionalization. For this project, the South Carolina Department of Mental Health will subcontract with the Medical University of South Carolina to evaluate the efficacy of TCL/PACT versus traditional Department of Mental Health care in the rural setting. Eligible clients for this controlled experiment, entailing random assignment to the experimental and control conditions, must be between the ages of 18 and 65 years, with primary DSM III-R diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder, major depression recurrent with psychotic features, and/or other psychotic disorders. An anticipated 120 patients will participate; 60 in each group. A potential target population of 163 persons (48 percent female and 83 percent African American) has already been identified through the collaborative efforts of numerous agencies and primary care providers in the participating counties. The hypotheses to be tested focus on expected change in seven areas pertaining to patients': 1) functioning; 2) quality-of-life; 3) family relationships; 4) medical health status; 5) mental health status; 6) service utilization; and 7) cost. There are no previous controlled studies on a TCL/PACT application for rural-based care.